title: Access to neuropsychologic services after pediatric brain tumor.
abstract: BACKGROUND
  Increasing survival rates for children with brain tumors creates a greater need for neuropsychologic follow-up and intervention. The aim of this study was to evaluate rates of referral by medical doctors to neuropsychologic services and patient and treatment factors that differentiated referred and nonreferred patients.
  
  
  METHODS
  Data were retrieved from medical records of all pediatric brain tumor patients in southern Sweden diagnosed between 1993 and 2004 who survived more than 1 year (n = 132). Characteristics of the patients, the cancer, and treatment received were then compared for patients who were and were not referred for neuropsychologic examination during that period.
  
  
  RESULTS
  Sixty-four (48%) of the pediatric brain tumor patients were referred for neuropsychologic evaluation. These patients had significantly larger tumors, more recurrences of cancer, and increased intracranial pressure at diagnosis when compared with the nonreferred group (n = 68). However, most of the patients in the nonreferred group either had significant risk factors for cognitive impairment or were reporting impairments that would suggest a referral was warranted.
  
  
  CONCLUSIONS
  Given the high rates of cognitive impairment in children with brain tumors, referral to neuropsychologic services should be considered in all survivors. In addition to improving long-term adjustment, systematic referral can provide data on cognitive impairments, making it possible to evaluate different cancer treatment protocols not only in terms of survival but also in terms of quality of survival. Greater efforts are needed to disseminate and raise awareness about published guidelines on the long-term care of pediatric brain tumor patients.
authors.affiliation: Department of Psychology, Lund University, Lund, Sweden; Department of Pediatrics, Skåne University Hospital, Lund, Sweden. Electronic address: ingrid.tonning-olsson@skane.se.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Tonning Olsson
authors.forename: Sean
authors.initials: S
authors.lastname: Perrin
authors.forename: Johan
authors.initials: J
authors.lastname: Lundgren
authors.forename: Lars
authors.initials: L
authors.lastname: Hjorth
authors.forename: Aki
authors.initials: A
authors.lastname: Johanson
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000523:psychology; D009483:Neuropsychological Tests; D010372:Pediatrics; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden
keywords: cognition; neuropsychological services; neuropsychology; pediatric brain tumor; rehabilitation